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write a brief Abstract on each of the two articles you located in the school library. The seminal article can be older than five years and the second article must be published within the last five years. Summarize the major concepts or definitions presen

Article1
 

write a brief Abstract on each of the two articles you located in the school library. The seminal article can be older than five years and the second article must be published within the last five years.

  • Summarize the major concepts or definitions presented in the article.
  • Identify which concepts are of interest to you and could be measured in your proposal.
  • Discuss how reviewing a seminal article and an article that captures new ideas helps to narrow your topic.
  • Evaluate if the article is useful for considering diversity, equity, and inclusion issues.

Child Abuse & Neglect 32 (2008) 1095–1108

Contents lists available at ScienceDirect

Child Abuse & Neglect

  • Child sexual abuse is largely hidden from the adult society
  • An epidemiological study of adolescents’ disclosures�

    Gisela Priebea,∗, Carl Göran Svedinb

    a Department of Child and Adolescent Psychiatry, IKVL, Lund University, Sofiavägen 2 D, S-221 41 Lund, Sweden
    b Department of Child and Adolescent Psychiatry, IMK, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    a r t i c l e i n f o

    Article history:
    Received 6 February 2007
    Received in revised form 1 April 2008
    Accepted 17 April 2008

    Keywords:
    Child sexual abuse
    Disclosure
    Adolescence
    Gender

    a b s t r a c t

    Objectives: The aim of this study was to investigate disclosure rates and disclosure patterns
    and to examine predictors of non-disclosure in a sample of male and female adolescents
    with self-reported experiences of sexual abuse.
    Method: A sample of 4,339 high school seniors (2,324 girls, 2,015 boys) was examined with
    a questionnaire concerning sexual experiences in this study with a focus on disclosure of
    sexual abuse (non-contact, contact or penetrating abuse, and including peer abuse).
    Results: Of the sample, 1,505 girls (65%) and 457 boys (23%) reported experience of sexual
    abuse. The disclosure rate was 81% (girls) and 69% (boys). Girls and boys disclosed most
    often to a friend of their own age. Few had disclosed to professionals. Even fewer said
    that the incident had been reported to the authorities. Logistic regression showed that it
    was less likely for girls to disclose if they had experienced contact sexual abuse with or
    without penetration, abuse by a family member, only a single abuse occasion or if they had
    perceived their parents as non-caring. Boys were less likely to disclose if they studied a
    vocational program, lived with both parents or had perceived their parents as either caring
    and overprotective or non-caring and not overprotective.
    Conclusions: Disclosing sexual abuse is a complex process. Much is hidden from the adult
    society, especially from professionals and the legal system. Since peers are the most com-
    mon receivers of abuse information, programs for supporting peers ought to be developed.
    Differences in disclosure patterns for girls and boys indicate that a gender perspective is
    helpful when developing guidelines for professionals.
    Practice implications: Professionals, especially in the school system, need to be more
    aware of the finding that few sexually abused children seek help from professionals or
    other adults and that support offers should be directly addressed not only to the vulnerable
    young persons themselves but also to peers who wish to help a friend.

    © 2008 Elsevier Ltd. All rights reserved.

    Introduction

    Most studies of disclosure of sexual abuse during childhood either focus on children’s disclosure in a professional setting
    such as in a forensic or clinical interview (Berliner & Conte, 1995; Bradley & Wood, 1996; DeVoe & Faller, 1999; Jensen,
    Gulbrandsen, Mossige, Reichelt, & Tjersland, 2005; Sjöberg & Lindblad, 2002; Sorensen & Snow, 1991; Svedin & Back, 2003)

    � The authors would like to acknowledge the Committee into knowledge concerning sexual exploitation of children in Sweden (S 2003:5) at the Swedish
    Social Ministry, the Crime Victim Compensation and Support Authority in Sweden and Her Majesty Queen Silvia’s Jubilee Foundation for their financial
    support to the project.

    ∗ Corresponding author.

    0145-2134/$ – see front matter © 2008 Elsevier Ltd. All rights reserved.
    doi:10.1016/j.chiabu.2008.04.001

    http://www.sciencedirect.com/science/journal/01452134

    dx.doi.org/10.1016/j.chiabu.2008.04.001

    1096 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    or on population-based retrospective reports from adults (Arata, 1998; Collings, 1995; Finkelhor, Hotaling, Lewis, & Smith,
    1990; Hanson, Resnick, Saunders, Kilpatrick, & Best, 1999; Roesler, 1994; Ruggiero et al., 2004; Smith et al., 2000; Somer &
    Szwarcberg, 2001; Tang, 2002).

    An advantage of population-based studies is that they can collect information even from participants who never disclosed
    their experience of sexual abuse prior to their participation in the study and who have never been in contact with the
    professional system. This may be of great interest for public health policy and for support services intended for sexually
    abused persons. The disclosure rates in the above named retrospective studies with adults are between 31% and 41% for
    disclosure during childhood and between 58 and 72% for lifetime disclosure. Peer abuse (peer defined as a person not more
    than five years older than the victim) is included in some of these studies, while it is not specified in other studies and
    excluded in one (Arata, 1998).

    Although it can be expected that there is less recall bias in adolescent retrospective studies since the self-reported sexual
    abuse is closer in time there are surprisingly few retrospective studies with adolescent participants. It is difficult to compare
    the few available studies since, for example, Kogan (2004) only included girls, Edgardh and Ormstad (2000) included both
    boys and girls while others do not present separate results for boys and girls (Fergusson, Lynskey, & Horwood, 1996; Helweg-
    Larsen & Larsen, 2006; Kellogg & Huston, 1995). The lowest disclosure rate (56%) is reported for boys (Edgardh & Ormstad,
    2000) while the other studies present disclosure rates ranging between 74% and 87%. All adolescent studies included both
    adult and peer abuse.

    Disclosing adolescents usually talk to friends or parents (Edgardh & Ormstad, 2000; Fergusson et al., 1996; Kellogg &
    Huston, 1995). Friends as recipients of disclosure are of increasing importance for adolescents while younger children disclose
    more often to an adult (Kogan, 2004). Few disclosing adolescents, between 3% and 13%, had talked to an adult professional
    (Edgardh & Ormstad, 2000; Kellogg & Huston, 1995; Kogan, 2004). This is in line with findings from retrospective studies
    with adults (Arata, 1998; Collings, 1995; Hanson et al., 1999; Smith et al., 2000; Tang, 2002).

    Few retrospective studies of adolescents have analyzed variables other than disclosure rates and recipients of disclosure.
    Kogan (2004) investigated how survivor characteristics, abuse characteristics and family context attributes were related
    to the timing and the recipient of disclosure. The identity of the recipient of the disclosure (adult, peer only, none) was
    related to age of onset, penetration, fear for one’s life during the abuse, injury during the abuse, family structure, and
    the age differential between the victim and the perpetrator while the timing of disclosure was related to age of onset, a
    known perpetrator, a familial relationship with the perpetrator, and a history of drug abuse in the household. The disclosure
    recipient or disclosure timing were not associated with race/ethnicity, parental education, household income and house-
    hold alcohol abuse. Kellogg and Huston (1995) studied the reasons for disclosure or non-disclosure. In general, fear and
    embarrassment were the most common reasons for delay or non-disclosure, but there were also differences between ethnic
    groups.

    Disclosure of sexual abuse is usually regarded as beneficial to the exposed child (Arata, 1998; Paine & Hansen, 2002).
    However, previous studies with children in forensic samples (Elliott & Briere, 1994; Nagel, Putnam, Noll, & Tricket, 1997),
    undergraduate female students (Sinclair & Gold, 1997) and adult women (Ruggiero et al., 2004) have not shown any direct link
    between disclosure and a positive mental health outcome. Association between current perceived mental health and disclo-
    sure and the role of general parental support for young persons’ disclosure has not yet, to our knowledge, been investigated
    in population-based studies with adolescents.

    Studies about the role of abuse-specific parental support in relation to disclosure have shown that the child’s willingness
    to disclose in a professional context increased when the mother was supportive and believed in the child’s disclosure (Elliott
    & Briere, 1994; Lawson & Chaffin, 1992). General parental support and care seem to be a good predictor for recovery after
    sexual abuse (Lynskey & Fergusson, 1997; Spaccarelli & Kim, 1995). Sinclair and Gold (1997) found that general parental
    support was not related to withholding disclosure from others, but it is unclear if parental support at the time of the study
    or during childhood was measured.

    Previous studies of adolescents about disclosure of sexual abuse include female-only samples or mixed samples that
    either include small groups of boys who reported sexual abuse or that do not show separate results for boys or girls. As group
    differences between boys and girls concerning prevalence and sexual abuse characteristics are well-documented (Watkins &
    Bentovim, 1992), it can be expected that there are differences concerning disclosure rates, disclosure patterns and predictors
    for disclosure or non-disclosure, too. There is a need for studies that include and show sufficient numbers of both boys and
    girls who report sexual abuse.

    This study is intended to contribute data about disclosure of sexual abuse from a large population-based sample of
    adolescents with self-reported experiences of child sexual abuse including peer abuse. The specific aims of this study were

    • to investigate disclosure rates and disclosure patterns associated with recipients of disclosure, abuse characteristics, socio-
    demographic variables, perception of parents when growing up and current perceived mental health, separate for boys
    and girls,

    • to examine predictors of non-disclosure, separate for boys and girls.

    No specific hypotheses are stated as the approach is basically exploratory. All variables in the analysis are expected to be
    associated with disclosure.

    G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108 1097

    Method

    Participants

    This study was a part of the Swedish base for comparative studies under the aegis of the Baltic Sea Regional Study on
    Adolescent Sexuality and the aim was to obtain a representative sample of high school seniors (3rd year high school students)
    in each country. Following the common guidelines the capital (Stockholm), one large port (Malmö) and some smaller cities
    (Luleå, Haparanda and Falköping) were chosen in Sweden. All 3rd year students (high school seniors) in all high schools
    in these cities were included in the initial group. Ninety-eight percent of all students finishing grade 9 in the Swedish
    compulsory school system enter the high school system (grades 10–12) each year. According to official statistics, about 90%
    of Swedish 18 year olds are enrolled in high school, 2% are studying in other education alternatives such as university and
    8% are not studying (Sweden’s Statistical Database, 2003).

    In the high schools of the participating cities 10,751 high school seniors were registered. At the time of the implementation
    of the study in the year 2003, there were 17 different national educational programs which can be classified as either academic
    or vocational at high school in Sweden. According to the sampling plan, only whole classes were selected, representing 50%
    of all students at each of the national educational programs in each town. If there was only one class in a program in a town,
    the whole class was selected. This resulted in a selection of 5,623 students (52.3% of the enrolled students), and 4,377 of
    them choose to participate in the study. Thirty-eight questionnaires were excluded as being incompletely filled-in. The final
    number of participants was consequently 4,339 (n = 2,324 girls and n = 2,015 boys), resulting in a response rate of 77.2%. The
    mean age of the participants was 18.15 years (SD = .74). In this study a subsample is used that consists of all participants who
    reported experience of sexual abuse and who answered to questions about disclosure of the abuse (n = 1,493, mean age 18.17
    years, SD = .68).

    Procedure

    The director of the entire school system in each participating community was asked to grant permission to present the
    research project to the principal of each high school. Once permission was given by the principal of a school, all students
    in the selected classes were asked for and gave consent to participate based on their consideration of oral and written
    information. One assistant from the research group visited each class to distribute the questionnaires and then collect them
    after the students had finished them. In order to ensure that the students could not influence each other, they completed
    the questionnaires at the same time in the classroom. If the classroom was too small to guarantee privacy another room
    was chosen. The anonymous questionnaires were placed in unmarked envelopes, sealed by the students, and collected by
    the omnipresent research assistant. The students were given oral and written information about where to get counseling if
    participation had caused feelings of distress.

    Measures

    The self-report questionnaire used in the study was based on a Norwegian survey of young people’s attitudes towards
    sexuality and sexual abuse (Mossige, 2001). Questions from other Nordic surveys concerning young people’s sexual experi-
    ences (Edgardh, 2001; Hammarén & Johansson, 2001, 2002; Tambs, 1994) and questions especially formulated for the study
    were added. The survey included questions about background variables, consensual sexuality, sexual abuse experiences, own
    sexual abusive behavior, sexual attitudes, experiences with pornography and experiences with sexual exploitation (to sell
    sex for compensation). There were in total 65 questions. The participants needed between 30 and 60 minutes to complete
    the questionnaire. In the analyses for this paper, variables about background and sexual abuse experiences were used.

    A wide definition of sexual abuse including lifetime prevalence of non-contact abuse, contact abuse without penetration
    and penetrating abuse by both adult and peer offenders was used. The participants were asked if they had been exposed to
    any of the following against their will: (1) non-contact abuse “somebody exposed him/herself indecently towards you,” (2)
    contact abuse “somebody has pawed you or touched your body in an indecent way,” “you masturbated somebody else,” (3)
    penetrative abuse (not specifying if for example fingers or devices were used) “you have had sexual intercourse,” “you have
    had oral sex,” “you have had anal sex.”

    Participants who had reported any of the above mentioned experiences of sexual abuse were asked to answer a question
    about how many times they had been exposed against their will and to describe the abuse characteristics on the first abuse
    occasion (participant’s age, offender’s age and gender, relation to the offender, victim or offender on alcohol or drugs, kinds of
    persuasion/pressure/force, including physical force or physical violence, used by the offender). Finally, two questions about
    disclosure of any abuse occasion were asked. The first question was “Could you talk to someone about what happened?”
    with “yes” or “no” as possible answers. The second question was “If yes, whom did you talk to?” It was possible to check
    several of the eight different alternatives for an answer (see Table 2) and to indicate if the incident was reported to social
    authorities or police.

    The survey included questions about background variables such as gender, the educational program, immigrant status
    (first or second generation), family structure and parents’ socio-economical status. The International Socioeconomic Index
    (ISEI) was used to classify the occupational status of the parent or parents (Ganzeboom, de Graaf, & Treiman, 1992). The ISEI

    1098 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    has values ranging from 0 to 90 and measures the attributes of occupation that convert a person’s education into income
    and status.

    The Mental Health scale consisted of six slightly modified items from the SCL-90 (Derogatis, 1977) about symptoms of
    anxiety and depression experienced during the preceding week (see Table 4). Each question was scored from 1 (does not
    correspond at all) to 4 (corresponds exactly) and consequently the total score of the Mental Health scale ranged from 6 to
    24. The internal consistency, assessed using Cronbach’s alpha, was .83. A cut off was set at the 80th percentile received by
    the participants in the total sample, resulting in a cut off point of ≥19.

    Nine of 25 items from the Parental Bonding Instrument (Parker, 1990; Parker, Tupling, & Brown, 1979) were included in the
    questionnaire. The Parental Bonding Instrument measures two fundamental parenting dimensions, care and overprotection.
    Five items from the care dimension (item 2, 5, 6, 14 and 18 in the original scale, Parker et al., 1979) and four items from
    the overprotection dimension were used (item 9, 13, 15 and 23 in the original scale, Parker et al., 1979). Each question was
    scored from 1 (does not correspond at all) to 6 (corresponds exactly). The score for the caring dimension ranged between 5
    and 30, high values indicating high care, and between 4 and 24 for the overprotection dimension, high values indicating high
    overprotection. Cronbach’s alpha was .70 for the care dimension and .75 for the overprotection dimension. Cut off values
    based on the data from the total sample were ≤20 for the care score (at the 25th percentile) and ≥16 for the overprotection
    score (at the 80th percentile). The cut off values were used in the calculation of the four types of parental bonding (Table 4).

    The data for girls and boys were analyzed separately. This does not mean that girls and boys as a group are assumed to have
    the same experiences concerning disclosure and related variables. When differences between girls and boys are described
    in the paper, usually the term “gender” is used instead of “sex” in order to not confuse sex and sexual activity.

    Ethical considerations

    The study was approved by the Regional Ethics Review Board in Lund.

    Results

    Sexual abuse rates

    Of the total sample of 2,324 girls and 2,015 boys, 65% of the girls and 23% of the boys reported some form of sexual abuse
    experience. Of the girls who reported experiences of sexual abuse, 10.0% reported non-contact abuse, 69.2% contact abuse
    without penetration and 20.8% penetrating abuse. Non-contact abuse was reported by 18.4% of the boys who reported sexual
    abuse, while 57.3% reported contact abuse and 24.3% penetrating abuse (Table 1). Participants with experiences of different
    kinds of abuse were categorized according to the most severe kind of abuse they had reported.

    Disclosure rates and recipients of disclosure

    Table 1 shows that out of the 1,962 participants who reported experience of sexual abuse, 261 (17.3%) of the girls and
    208 (45.5%) of the boys did not answer the questions about disclosure. A data analysis of these non-completers was done
    by carrying out a logistic regression analysis separately for girls and boys including abuse severity, parents’ employment,
    family structure, educational program, perceived mental health and immigrant background as independent variables and
    non-completers as dependent variable. Boy non-completers were about two times more likely to have one or both parents
    unemployed than completers (aOR = 2.18, CI = 1.49–3.19). Girl non-completers were significantly more often enrolled in a
    vocational educational program (aOR = 1.40, CI = 1.05–1.86) and reported less often exposure to penetrating abuse compared
    to completers (aOR = .40, CI = .23–.68). Concerning all other variables in the analyses, there were no significant differences
    between completers and non-completers.

    All participants had very low numbers of missing answers for questions not related to sexual abuse, for example back-
    ground variables, perception of parents when growing up and questions about perceived mental health (0–2.8% of those
    who had not answered to the disclosure questions and .4–1.8% of those who had answered to the disclosure questions).

    In the following, results from those adolescents who completed the questions about disclosure are presented. Table 2
    shows that girl completers reported that they had talked to somebody about the sexual abuse significantly more often than
    boys. Most of them named one or two of the recipients listed in Table 2 (girls, 75.9%, boys 78.1%). Six or more different
    recipients were marked by 2.1% of the disclosing girls and 4.8% of the disclosing boys. Both girls and boys mentioned most
    often a friend of their own age as the person they had disclosed to.

    Table 2 also shows that few young persons (8.3%) had talked to a professional about the abuse. Professionals included
    teachers, social workers, nurses or other persons working professionally with children and adolescents. These persons are
    required by Swedish law (mandatory reporting) to report to the social authorities all cases of child sexual abuse that come to
    their attention. A disclosure made to a professional resulted significantly more often (33.9%) in a report to the social authorities
    or the police, compared to a disclosure made to someone other than a professional, 4.4% (OR = 11.17, CI = 7.10–17.58). In all,
    6.8% of the adolescents answered that the incident had been reported to the social authorities or police.

    Table 3 shows that the severity of the sexual abuse seemed to influence the young person’s decision to at least disclose
    the experience to someone. The severity also affected disclosure to a member of their families, to a professional, and if the
    abuse was reported to the social authorities or to the police.

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    Table 1
    Participants: completers and non-completers.

    Type of sexual abuse Could talk to someone about the sexual abuse

    Girls, n = 1,505 Boys, n = 457

    All, n (%) Completers, n (%) Non-completers, n (%) OR (CI 95%) All, n (%) Completers, n (%) Non-completers, n (%) OR (CI 95%)

    Non-contact 150 (10.0) 116 (9.3) 34 (13.0) 1.46 (.97–2.19) 84 (18.4) 45 (18.8) 39 (18.7) 1.05 (.65–1.68)
    Contact 1,042 (69.2) 848 (68.2) 194 (74.3) 1.35 (1.00–1.83) 262 (57.3) 152 (61.0) 110 (52.9) .72 (.49–1.04)
    Penetrating 313 (20.8) 280 (22.5) 33 (12.7) .50 (.34–.74) 111 (24.3) 52 (20.9) 59 (28.4) 1.50 (.98–2.30)

    Total 1,505(100) 1,244 (100) 261 (100) 457 (100) 249 (100) 208 (100)

    1100 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    Table 2
    Disclosure of sexual abuse, rates (n = 1,493).

    Could talk to . . .a Girls, n = 1,244 Boys, n = 249

    n (%) n (%) OR (CI 95%)

    Nobody 231 (18.6) 77 (30.9) 1.96 (1.45–2.66)

    Somebody 1,013 (81.4) 172 (69.1) .51 (.38–.69)
    Friend of my age 781 (62.8) 111 (44.6) .48 (.36–.63)
    Mother 351 (28.2) 43 (17.3) .53 (.37–.75)
    Father 160 (12.9) 34 (13.7) 1.07 (.72–1.60)
    Sibling 187 (11.6) 29 (11.6) .75 (.49–1.13)
    Other person 128 (10.3) 48 (19.3) 2.08 (1.45–3.00)
    Professional 117 (9.4) 7 (2.8) .28 (.13–.61)
    Adult relative or friend 111 (8.9) 33 (13.3) 1.56 (1.03–2.36)

    The incident was reported to social authorities or police 91 (7.3) 11 (4.4) .59 (.31–1.11)

    a Several alternatives possible.

    The more severe the sexual abuse was, the more seldom both girls and boys had talked to mother, father or a sibling.
    Disclosure to a professional was associated with higher rates of more severe abuse (contact abuse with or without penetration
    compared to non-contact abuse) for girls (OR = 3.12, CI = 1.13–8.61), but with lower rates of more severe abuse for boys (OR = .15,
    CI = .03–.71). Talking to a professional was also associated with being abused by an older person (age difference ≥5 years vs.
    <5 years) for girls (OR = 1.65, CI = 1.10–2.49), while there was no such association for boys.

    For boys, all but one of the reports to social authorities or police concerned non-contact abuse. For girls, the
    proportion of reported incidents was highest for non-contact abuse, but even cases of more severe abuse were
    reported.

    Of the disclosers, 42.6% of the boys and 37.9% of the girls mentioned “friend of my own age” as the only recipient. A friend
    of one’s own age may include both peer(s) and romantic partner. Disclosure to a friend of one’s own age was associated
    with higher rates of more severe abuse (non-contact abuse vs. contact abuse with or without penetration; girls OR = 1.92,
    CI = 1.22–3.03, boys OR = 2.58, CI = 1.04–6.43) and being abused by a peer (age difference ≥5 years vs. <5 years; girls OR = 2.35, CI = 1.80–3.05, boys OR = 2.40, CI = 1.22–4.73).

    Univariate analyses

    Table 4 shows the associations between disclosure and abuse characteristics, socio-demographic variables, parental
    bonding and mental health.

    Non-disclosing girls reported more often penetrating abuse, less frequent abuse, and abuse by a family member, a relative
    or a friend, compared to disclosing girls. They also reported less frequently that the perpetrator had used alcohol or drugs
    at the first abuse occasion. Non-disclosing girls were more often first or second generation immigrants compared to native
    Swedes.

    Girl non-disclosers had significantly lower scores on the care dimension and higher scores on the overprotection dimen-
    sion on the Parenting Bonding Instrument (t-test care: t(df) = 5.74(1235), p < .001, overprotection: t(df) = −2.91(1235), p = .007). Girl non-disclosers more often perceived their parents as less caring in combination with lower overprotection or higher overprotection, than girl disclosers.

    Non-disclosing boys were sexually abused more often by a family member, a relative or a friend than boy disclosers. Boy
    non-disclosers were also more often studying at a vocational program and lived more often together with both parents than
    disclosing boys.

    Boy non-disclosers had significantly lower scores on the care dimension and higher scores on the overprotection dimen-
    sion on the Parenting Bonding Instrument (t-test care: t(df) = 2.18(246), p = .030, overprotection: t(df) = −2.00(246), p = .046).
    Non-disclosing boys perceived their parents during their childhood more often as less caring in combination with lower
    overprotection, than boy disclosers.

    Adolescents who reported sexual abuse experiences reported significantly more symptoms at the Mental Health Scale,
    indicating that their perceived mental health was poorer compared to adolescents without these experiences (girls: M(SD):
    abused 15.38 (4.68), not abused 14.00 (4.68), t (df) = −6.79 (2298), p < .001; boys: M(SD): abused 14.21 (4.71), not abused 12.65 (4.37), t (df) = −6.31 (703.20), p < .001). The effect sizes were moderate (girls: .30, boys: .34). Adolescents who reported sexual abuse had also significantly more often a total score above the cut off in the Mental Health Scale (girls: OR = 1.60, CI = 1.30–1.97; boys: OR = 2.10, CI = 1.60–2.77). In general, non-disclosers reported more symptoms than disclosers (girls: M(SD): discloser 15.27 (4.71), non-discloser 16.26 (4.7), t (df) = −2.89 (1232), p = .004; boys: M(SD): discloser 13.97 (4.55), non-discloser 15.53 (4.80), t (df) = −2.45 (246), p = .015). The effect sizes were low for girls (.21) and moderate for boys (.34). On the other hand, there were no significant differences between disclosers and non-disclosers when the results were analyzed separately for non-contact abuse, contact abuse and penetrating abuse. Disclosers and non-disclosers did not differ concerning a total score above the cut off in the Mental Health Scale (Table 4).

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    Table 3
    Severity of the sexual abuse and disclosure rates (n = 1,493).

    Could talk to . . .a Girls, n = 1,244 Boys, n = 249

    Non-contact, n = 116 Contact, n = 848 Penetrating, n = 280 p Non-contact, n = 45 Contact, n = 152 Penetrating, n = 52 p
    n (%) n (%) n (%) n (%) n (%) n (%)

    Nobody 6 (5.2) 153 (18.0) 72 (25.7) <.001b 10 (22.2) 47 (30.9) 20 (38.5) .226b

    Somebody
    Friend of my age 77 (66.4) 539 (63.6) 165 (58.9) .267b 20 (44.4) 74 (48.7) 17 (32.7) .135b

    Mother 76 (65.5) 232 (27.4) 43 (15.4) <.001b 21 (46.7) 20 (13.2) 2 (3.8) <.001b

    Father 42 (36.2) 102 (12.0) 16 (5.7) <.001b 18 (40.0) 14 (9.2) 2 (3.8) <.001b

    Sibling 35 (30.2) 125 (14.7) 27 (9.6) <.001b 11 (24.4) 17 (11.2) 1 (1.9) .003b

    Other person 12 (10.3) 85 (10.0) 31 (11.1) .882b 7 (15.6) 31 (20.4) 10 (19.2) .770b

    Professionalc 4 (3.4) 61 (7.2) 52 (18.6) <.001b 4 (8.9) 2 (1.3) 1 (1.9) .035d

    Adult relative or friend 18 (15.5) 72 (8.5) 21 (7.5) .029b 10 (22.2) 19 (12.5) 4 (7.7) .099b

    The incident was reported to social authorities or police 17 (14.7) 47 (5.5) 27 (9.6) <.001b 10 (22.2) 0 1 (1.9) <.001b

    a Several alternatives possible.
    b �2.
    c “Professional” includes teacher, social worker, nurse or some other person who professionally works with children and youth.
    d Fisher’s exact test.

    1102 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    Table 4
    Disclosure and abuse characteristics, socio-demographic variables, parental bonding and mental health.

    Variable Girls, n = 1,131–1,244 Boys, n = 227–249

    Discloser, n (%) Non-discloser, n (%) Discloser, n (%) Non-discloser, n (%)

    Abuse characteristics, ever
    Severity

    Non-contact 110 (10.9) 6 (2.6)*** 35 (20.3) 10 (13.0)
    Contact 695 (68.6) 153 (66.2)** 105 (61.0) 47 (61.0)
    Penetration 208 (20.5) 72 (31.2)*** 32 (18.6) 20 (26.0)

    Frequency
    Once 394 (39.3) 94 (41.8) 78 (47.0) 27 (38.6)
    2–5 times 437 (43.6) 107 (47.6) 67 (40.4) 33 (47.1)
    >5 times 172 (17.1) 24 (10.7)* 21 (12.7) 10 (14.3)

    Abuse characteristics, first abuse occasion
    Relation to perpetrator

    Stranger 619 (63.0) 89 (41.4)*** 103 (64.0) 30 (43.5)**
    Family/relative 35 (3.6) 17 (7.9)*** 2 (1.2) 4 (5.8)*
    Friend/acquaintance 329 (33.5) 109 (50.7)*** 56 (34.8) 35 (50.7)*

    Offender on alcohol/drugs
    No 561 (61.4) 149 (68.7) 88 (55.0) 46 (64.8)
    Yes 353 (38.6) 68 (31.3)* 72 (45.0) 25 (35.2)

    Victim on alcohol/drugs
    No 787 (78.9) 180 (80.0) 110 (67.1) 52 (72.2)
    Yes 210 (21.1) 45 (20.0) 54 (32.9) 20 (27.8)

    Age difference
    <5 years 397 (39.2) 97 (42.0) 94 (54.7) 41 (53.2) ≥5 years 449 (44.3) 102 (44.2) 61 (35.5) 25 (32.5) Unknown 167 (16.5) 32 (13.9) 17 (9.9) 11 (14.3)

    Victims age ≤15 years
    No 379 (38.7) 88 (39.6) 92 (56.1) 34 (50.7)
    Yes 601 (61.3) 134 (60.4) 72 (43.9) 33 (49.3)

    Physical violence
    No 791 (78.1) 172 (74.5) 149 (86.6) 68 (88.3)
    Yes 222 (21.9) 59 (25.5) 23 (13.4) 9 (11.7)

    Socio-demographic variables
    First or second generation immigrants

    No 659 (65.8) 134 (58.8) 105 (61.4) 44 (57.9)
    Yes 343 (34.2) 94 (41.2)* 66 (38.6) 32 (42.1)

    Educational program
    Academic 702 (69.3) 152 (65.8) 111 (64.5) 36 (46.8)
    Vocational 311 (30.7) 79 (34.2) 61 (35.5) 41 (53.2)**

    Family structure
    Living with both mom and dad 555 (55.2) 123 (53.5) 97 (56.4) 53 (70.7)
    Not living with both mom and dad 450 (44.8) 107 (46.5) 75 (43.6) 22 (29.3)*

    Parents’ socioeconomic status (ISEI)
    1–25th percentile 245 (25.3) 56 (26.7) 53 (32.7) 16 (24.6)
    26–50th percentile 250 (25.8) 66 (31.4) 44 (27.2) 22 (33.8)
    51–75th percentile 295 (30.5) 55 (26.2) 33 (20.4) 21 (32.3)
    76–100th percentile 178 (18.4) 33 (15.7) 32 (19.8) 6 (9.2)

    Both parents employed
    Yes 671 (66.7) 140 (60.9) 112 (66.3) 46 (60.5)
    No 335 (33.3) 90 (39.1) 57 (33.7) 30 (39.5)

    Parental bonding
    High care/low overprotection 649 (64.5) 108 (46.8)*** 99 (57.6) 28 (36.8)*
    High care/high overprotection 111 (11.0) 25 (10.8) 21 (12.2) 13 (17.1)
    Low care/low overprotection 164 (16.3) 57 (24.7)*** 34 (19.8) 26 (34.2)**
    Low care/high overprotection 82 (8.2) 41 (17.7)*** 18 (10.5) 9 (11.8)

    Mental health scale ≥19
    No 724 (72.0) 152 (66.7) 141 (82.0) 56 (73.7)
    Yes 282 (28.0) 76 (33.3) 31 (18.0) 20 (26.3)

    Note: *p < .05, **p < .01, ***p < .001, bivariate logistic regression cOR, see also Tables 5a and 5b.

    G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108 1103

    Table 5a
    Summary of logistic regression analysis (LR backward) for variables predicting non-disclosure of sexual abuse, girls.

    Variable cOR Step 1 Final step (step 5)

    aOR CI (95%) pa aOR CI (95%) pa

    Sexual abuse category .022 .031
    Non-contact (ref)
    Contact 4.04 4.35 1.53–12.38 .006 4.07 1.44–11.52 .008
    Penetrating 6.35 4.30 1.44–12.82 .009 3.87 1.31–11.43 .014

    Frequency of the sexual abuse <.001 .001 Once (ref) 2–5 times 1.03 .90 .63–1.27 .532 .92 .66–1.31 .655 More than 5 times .59 .32 .18–.57 <.001 .34 .19–.60 <.001

    Relation to the offender <.001 <.001 Stranger (ref) Family/relative 3.38 2.92 1.46–5.82 .002 3.02 1.54–5.92 .001 Friend/acquaintance 2.30 1.89 1.32–2.70 .001 1.94 1.37–2.75 <.001

    Offender on alcohol or drugs .73 .75 .53–1.08 .119 – – –
    Immigrant 1.35 .94 .66–1.33 .722 – – –
    Educational program 1.17 .88 .62–1.26 .493 – – –
    Family structure 1.07 1.00 .71–1.39 1.0 – – –

    Parental bonding .002 .001
    High care, low overprotection (ref)
    High care, high overprotection 1.35 1.15 .67–2.00 .611 1.14 .66–1.96 .641
    Low care, low overprotection 2.09 2.02 1.35–3.04 .001 2.04 1.36–3.05 .001
    Low care, high overprotection 3.01 2.02 1.21–3.37 .007 2.04 1.23–3.37 .005

    Notes: Description of the variables included in the analysis: disclosure of sexual abuse – yes = 0, no = 1 (dependent variable); sexual abuse category – non-
    contact abuse = 0 (ref), contact abuse = 1, penetrating abuse = 2; frequency of the sexual abuse – once = 0 (ref), 2–5 times = 1, more than five times = 2; relation
    to the offender at first abuse occasion – stranger = 0 (ref), family/relative = 1, friend/acquaintance = 2; offender on alcohol or drugs at first abuse occasion
    – no = 0, yes = 1; immigrant – no = 0, yes = 1; educational program – academic = 0, vocational = 1; family structure – living with both mom and dad = 0, not
    living with both mom and dad = 1; parental bonding – high care, low overprotection (optimal bonding) = 0 (ref), high care, high overprotection (affectionate
    constraint) = 1, low care, low overprotection (absent/weak bonding) = 2, low care, high overprotection (affectionless control) = 3.

    a Wald statistic.

    Multivariate analyses—predictors of non-disclosure

    As described above, a number of variables were associated with disclosure versus non-disclosure, when examined sepa-
    rately. These variables were four sexual abuse characteristics (sexual abuse category, frequency of the sexual abuse, relation
    to the offender at first abuse occasion and offender on alcohol or drugs at first abuse occasion), three socio-demographic
    variables (immigrant, educational program and family structure) and parental bonding. A logistic regression analysis (LR
    backward) was conducted to examine if the associations remained when controlled for the other variables.

    Tables 5a and 5b show that four variables remained significant for girls and three for boys each as overall predictors of
    disclosure versus non-disclosure in the final logistic regression model. Parental bonding was the only common variable for
    both genders. Specifically, girls were less likely to disclose when (a) they had been exposed to contact or penetrating abuse
    compared to non-contact abuse, (b) they had been exposed to a single abuse occasion compared to more than five abuse
    occasions, (c) the offender at first/only abuse occasion had been a family member/relative or friend/acquaintance compared
    to a stranger and (d) they had perceived their parents as non-caring when growing up. Boys were less likely to disclose when
    (a) they participated in a vocational educational program, (b) they were living with both mom and dad and (c) they had
    perceived their parents as either caring and overprotective or non-caring and not overprotective compared to caring and not
    overprotective.

    Discussion

    The aim of this study was to investigate disclosure rates and disclosure patterns and to examine predictors of non-
    disclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse. The main results from
    this study may be summarized in six main findings.

    Disclosure rate

    The disclosure rate (81% for girls and 69% for boys) was high in our study of adolescents compared to retrospective studies
    of adults presenting childhood disclosure rates between 31% and 42% (Arata, 1998; Finkelhor et al., 1990; Hanson et al., 1999;
    Smith et al., 2000; Tang, 2002). Studies of adolescents show high rates similar to those in our study (Edgardh & Ormstad,
    2000; Fergusson et al., 1996; Helweg-Larsen & Larsen, 2006; Kellogg & Huston, 1995; Kogan, 2004). One explanation of

    1104 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    Table 5b
    Summary of logistic regression analysis (LR backward) for variables predicting non-disclosure of sexual abuse, boys.

    Variable cOR Step 1 Final step (step 5)

    aOR CI (95%) pa aOR CI (95%) pa

    Sexual abuse category .736
    Non-contact (ref)
    Contact 1.57 1.49 .52–4.26 .457 – – –
    Penetrating 2.19 1.57 .45–5.49 .483 – – –

    Frequency of the sexual abuse .669 –
    Once (ref)
    2–5 times 1.42 1.38 .66–2.92 .396 – – –
    More than 5 times 1.38 1.05 .37–3.00 .925 – – –

    Relation to the offender .156 –
    Stranger (ref)
    Family/relative 6.87 5.99 .74–48.24 .093 – – –
    Friend/acquaintance 2.15 1.54 .77–3.10 .225 – – –

    Offender on alcohol or drugs .66 .63 .32–1.27 .195 – – –
    Immigrant 1.16 .81 .39–1.68 .570 – – –
    Educational program 2.07 2.96 1.47–5.97 .002 3.20 1.65–6.21 .001
    Family structure .54 .38 .18–.79 .009 .43 .22–.86 .017

    Parental bonding .050 .013
    High care, low overprotection (ref)
    High care, high overprotection 2.19 2.43 .93–6.35 .070 2.76 1.12–6.80 .028
    Low care, low overprotection 2.70 2.76 1.24–6.12 .013 3.20 1.49–6.91 .003
    Low care, high overprotection 1.77 1.10 .32–3.77 .880 1.24 .41–3.71 .704

    Notes: Description of the variables included in the analysis: disclosure of sexual abuse – yes = 0, no = 1 (dependent variable); sexual abuse category – non-
    contact abuse = 0 (ref), contact abuse = 1, penetrating abuse = 2; frequency of the sexual abuse – once = 0 (ref), 2–5 times = 1, more than five times = 2; relation
    to the offender at first abuse occasion– stranger = 0 (ref), family/relative = 1, friend/acquaintance = 2; offender on alcohol or drugs at first abuse occasion
    – no = 0, yes = 1; immigrant – no = 0, yes = 1; educational program – academic = 0, vocational = 1; family structure – living with both mom and dad = 0, not
    living with both mom and dad = 1; parental bonding – high care, low overprotection (optimal bonding) = 0 (ref), high care, high overprotection (affectionate
    constraint) = 1, low care, low overprotection (absent/weak bonding) = 2, low care, high overprotection (affectionless control) = 3.

    a Wald statistic.

    the differences between retrospective studies of adolescents and adults could be that there is less recall bias in studies of
    adolescents as it is easier for them to remember that they disclosed to someone. Another explanation is that the studies of
    adolescents included peer abuse while several of the studies of adults did not specify if peer abuse was included and may
    have excluded it. The mean age at the first abuse occasion was relatively high in our study (14.4 years), which probably was
    due to the fact that peer abuse was included. We know from other studies that high disclosure rates are related to sexual
    abuse during adolescence (London, Bruck, Ceci, & Shuman, 2005) and that adolescents are more likely to make the decision
    to disclose compared to preschool children (Sorensen & Snow, 1991).

    The disclosure rate for boys was higher in our study than in Edgardh and Ormstad (2000) study. Nevertheless, the pattern
    in both studies is that the rates for boys are lower than those for girls.

    In this study, it was more likely that girls who had been exposed to non-contact abuse disclosed compared to girls exposed
    to contact abuse with or without penetration. This finding is supported by the lower disclosure rates in studies only including
    penetrating sexual abuse (Hanson et al., 1999; Smith et al., 2000). On the other hand, Kogan (2004) found that girls who
    experienced penetrating abuse were more likely to disclose to an adult than to non-disclose.

    Disclosures are hidden from adult society

    Even if the disclosure rate was high, child sexual abuse was largely hidden from the adult society. By far the most com-
    mon recipient of disclosure from both girls and boys was a friend of their own age and as many as 42% had only talked to
    a friend of their own age and nobody else. This was most evident when it came to peer abuse and one explanation could
    be that young people prefer to talk to a friend about their experiences and do not want to involve their parents. Our find-
    ings are in line with Kogan (2004), and one interpretation could be the adolescent’s fear of embarrassment, blame, and
    accusations.

    Data from other studies about disclosure during childhood suggest that most children make their initial disclosure to a
    parent or a parent-figure (Arata, 1998; Jensen et al., 2005; Paine & Hansen, 2002) while studies of older adolescents (Kellogg
    & Huston, 1995) and adult women (Ruggiero et al., 2004; Smith et al., 2000) about lifetime disclosure show that the victim
    would most often make the disclosure to a friend. In our study, we did not distinguish between initial disclosure and later
    disclosure. It can be presumed that our data reflect the increasing importance of friends at the same age (both peers and
    romantic partners) in late adolescence and the inclusion of peer abuse in the study. Even if they perceived their parents as
    supportive, those who disclose in late adolescence may prefer to talk to friends about sexual abuse, especially peer abuse.

    G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108 1105

    Gender differences in disclosure patterns

    There were several interesting differences in the disclosure patterns between the answers from girls and boys. Even when
    boys reported experiences of sexual abuse, many were hesitant to answer follow-up questions about the abuse, resulting in
    a high number of non-completers. This is a finding per se but, as a consequence, the results for boys have to be regarded with
    some caution. Boy completers had significantly more often not disclosed to anyone and fewer of them had talked to their
    mother or a friend but had instead more often talked to someone in the category “another” compared to girls. Boys from
    vocational educational programs were overrepresented among non-disclosers. For girls, disclosure was not associated with
    educational program. In Sweden vocational programs are often either male or female dominated while academic programs
    are more mixed. This means that boys at vocational programs often live in a male school context which may make it more
    difficult for them to disclose sexual abuse. Our results might indicate that boys make other choices or encounter other
    difficulties than girls when disclosing experience of sexual abuse. Boys who have been sexually abused by men do often
    report confusion over their sexual identity, fear of being regarded as homosexual by others and concern for being a potential
    offender or being regarded by others as a potential offender (Durham, 2003; Teram, Stalker, Hovey, Schachter, & Lasiuk,
    2006; Watkins & Bentovim, 1992). Men who had been abused by a woman have reported that they felt that in meeting with
    health professionals, some of these might have expectations like “this should be every man’s dream” (Teram et al., 2006).
    Especially peers’ negative reactions, both real and expected reactions, strongly influenced male adolescents’ decision not to
    tell about the sexual abuse they had experienced (Durham, 2003). Theories about masculinities and males sexualities offer
    the concept of hegemonic masculinity – the norm that “real men” are heterosexual and powerful (Connell, 2000; Kimmel,
    Hearn, & Connell, 2005) – and homophobia as a consequence of this (Kimmel, 1994). Sexually abused boys may feel that
    being a victim of sexual abuse is not compatible with appropriate masculinity (Browne, 1991; Durham, 2003; Holmes, Offen,
    & Waller, 1997).

    The professional system

    Few adolescents exposed to sexual abuse reported that they had talked to a professional about the abuse (9% of the girls
    and 3% of the boys) or that the incident had been reported to social authorities or the police (7% of the girls and 4% of the
    boys). These findings are well in line with other studies when it comes to professional contacts (Collings, 1995; Edgardh &
    Ormstad, 2000) and the frequency of incidents reported to the authorities is usually in the range between 6% and 15% (Arata,
    1998; Hanson et al., 1999; Helweg-Larsen & Larsen, 2006; Smith et al., 2000; Tang, 2002). In our study, girls who had been
    exposed to penetrating abuse had more often been in contact with a professional than girls exposed to less severe abuse. This
    indicates that girls who come to see a professional are more severe cases and in greater need for help. On the other hand,
    only one out of 52 boys exposed to penetrating abuse had been in contact with a professional, underlining men’s difficulties
    in talking about their abuse experiences. Less severe abuse was relatively more often reported to social authorities compared
    to severe abuse, especially if the victim was a boy.

    The low rate of disclosures to professionals could partially be explained by older children’s fears that a report to the
    authorities will be made (mandatory reporting). The support duty is maybe hindered by the report duty but so far there is
    no evidence that the disclosure rates to professionals would be substantially higher, if there was no mandatory reporting.
    The numbers are low in all studies that have come to our attention representing different countries and regions such as
    USA/Southern Alabama (Arata, 1998), USA/South Carolina (Hanson et al., 1999; Smith et al., 2000), South Africa (Collings,
    1995), Denmark (Helweg-Larsen & Larsen, 2006), and Hong Kong (Tang, 2002).

    It is important to note in this and other retrospective studies the possibility that not all adolescents who actually have
    been in contact with a professional were aware of this or remembered it correctly when asked in the study. Berliner and
    Conte (1995) found that, although all children in their study had been seen at least once by a person from the professional
    system, only 71% recalled this at follow-up on average 3.5 years later. Another source of recall bias could also be that contact
    abuse is more easily remembered than non-contact abuse when answering questions in a questionnaire, but on the other
    hand, as Bouvier et al. (1999) point out, the individual experience of the abuse may be very different irrespective of the
    severity of the abuse.

    Predictors of non-disclosure

    Even if a number of variables were associated with disclosure versus non-disclosure only few of them remained associated
    when controlled for in the logistic regression model. For girls, the severity and the frequency of the sexual abuse, the relation to
    the offender at first abuse occasion and the perception of parental bonding when growing up were identified as predictors of
    non-disclosure. For boys, the predictors of non-disclosure were educational program, family structure and parental bonding.
    Thus, the only predictor common for both genders was parental bonding. Compared to other types of parental bonding,
    young persons who had perceived their parents as caring and not overprotective were most likely to disclose. A plausible
    interpretation seems to be that growing up in a caring and not overprotective family climate facilitates young people’s talking
    to other people including both peers and parents about their abusive experience. Our results are, in a way, supported by the
    findings in studies of children undergoing forensic interviewing, in which abused children who had supportive caretakers
    were more likely to disclose than those who had not (Elliott & Briere, 1994; Lawson & Chaffin, 1992).

    1106 G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108

    There are few studies reporting on associations between disclosure/non-disclosure and abuse characteristics or socio-
    demographic variables. Associations similar to those we have found have been found between lower disclosure rates and
    contact abuse (Arata, 1998) and higher disclosure rate and the offender being a stranger (Arata, 1998; Hanson et al., 1999;
    Smith et al., 2000). In our study, socio-demographic variables had some importance only for the boys. The finding that boys
    living with both parents are less likely to disclose seems counter-intuitive and needs further exploration. As found in previous
    studies (Hanson et al., 1999; Kellogg & Huston, 1995) the associations between disclosure and socio-demographic variables
    seem to be weak for both girls and women.

    Mental health

    Both girls and boys with sexual abuse experiences reported significantly more mental health symptoms than participants
    without this experience, but the scores were not very high in either group. Concerning sexual abuse in general, girls and boys
    who had disclosed to somebody reported significantly better health than those who had not but when data were analyzed
    separately for non-contact, contact and penetrating abuse the findings could not be confirmed. Hanson et al. (1999) found
    no significant differences in prevalence for PTSD and Major Depression among those who disclosed versus not disclosed.
    This could be explained by the fact that disclosure for some is a relief but for others adds to the burden of being a victim. It
    might also reflect that a disclosure per se is not enough in order to get support and help to recover from the negative impact
    of sexual abuse.

    Our results must be interpreted with some caution. First, there was a 23% general drop-out rate from the study and a high
    drop-out rate among boys answering the follow-up questions concerning disclosure. A participation rate of 77% may be seen
    as acceptable to good since 10% of the pupils in the upper secondary schools in Sweden are usually absent on any day for
    a variety of reasons (illness, practical occupational experience). Truancy could also account for 3–4%, according to another
    Swedish study (Sundell, El-Khouri, & Månsson, 2005), and there is good reason to believe that the reported prevalence of
    sexual abuse would have been a little bit higher if these pupils had been present, since these student also are at higher risk
    for being a victim of crimes like theft and rape (Sundell et al., 2005). The number of boy non-completers not answering the
    disclosure questions is more problematic and the results may have been different as concerns both variety and statistical
    power had the response rate been higher. Since the analyses concerning non-completers did not show any decisive differences
    between this group and the others we decided to keep the boys in the analysis since the drop-out could be seen as a result
    per se, strengthening the view that boys experience greater difficulties in talking about their abuse history. Second, the
    study design allowed participants to report several kinds of sexual abuse with different severity or several abuse occasions
    without the possibility of identifying what kind of abuse or occasion they actually talked about with different persons.
    Another shortcoming of the study design, compared with for example Kogan (2004), was that the timing of the disclosure
    (immediate or delayed) was not measured. Third, there is the general validity problem that can arise in a retrospective study
    based only on self-reports (Hardt & Rutter, 2004). Recall bias about both the sexual abuse events and the disclosure process
    are to be expected but perhaps this is less of a problem with older adolescents than with adults since the self-reported
    events are closer in time. Fourth, the participants may be reluctant to report sexual abuse in a school setting as they are
    afraid of being identified. The high rates of reported abuse events contradict this but this could perhaps contribute to the
    drop-out rate on sensitive questions in the follow-up questions of sexual abuse. Fifth, due to the design of this study, the
    analyses were limited to between-group differences and it was not possible to analyze within-person-differences related to
    different situations and contexts. A qualitative approach would have fit these kinds of questions better with the pros and
    cons connected with this kind of design. Sixth, another topic is the students’ understanding of the wording in the questions. A
    sentence like “against your will” could for example have different meanings to different individuals depending on their earlier
    life events, gender, and culture. Hardt and Rutter (2004) addressed the problem that the ways in which the participants were
    asked about adverse experiences are likely to contribute to the validity of the reports. According to them, interviews allow
    a clarification of different understandings, but, on the other hand, questionnaires have a possible advantage in anonymity,
    which may facilitate valid response to questions on sensitive issues. Finally, it may be difficult to compare results from
    different studies as there are differences concerning the wording of the questions about sexual abuse and disclosure, the
    study settings, age limits and so on.

    Implications for practice

    Professionals, especially in the school system, need to be more aware of the finding that few sexually abused children
    seek help from professionals or other adults and that support offers should be directly addressed not only to the vulnerable
    young persons themselves but also to peers who wish to help a friend. For example, information about sexual abuse and
    available support for victims and peers should be included in family and sex education at schools. Education of teachers is
    also needed since sexuality in general, and sexual abuse in special, are sensitive and difficult topics to talk about. To provide
    the support system with education and guidelines is probably also crucial when it comes to support for both victims and
    their peers. Even if not all young people exposed to sexual abuse are in need of therapeutic help it is a matter of concern that
    so few abused young people, especially boys, are seen by a professional for assessment of their needs. It is important to take
    steps to achieve this since there is a two to fourfold increased risk for different psychiatric problems later in life (Fergusson
    & Mullen, 1999).

    G. Priebe, C.G. Svedin / Child Abuse & Neglect 32 (2008) 1095–1108 1107

    Conclusion

    The important message from this study is that sexual abuse is largely hidden from the adult society, especially for pro-
    fessionals and the legal system. Disclosing child sexual abuse is a complex process and when young persons disclose sexual
    abuse, friends seem to be the most important receivers of the information. The multiple logistic regression analysis shows
    that children’s difficulties with disclosure are associated with both abuse factors such as severity and frequency, with the
    relation to the perpetrator and with family background factors such as family structure and living in a caring environment.
    The implications for the society might be that it must consider relying to a lesser extent on established organizations for
    information and instead must find ways to give young people better information and guidance about how to support a sex-
    ually abused peer and how to mediate help when necessary. There are also different disclosure patterns for girls and boys.
    This indicates that a gender perspective may be helpful when developing support efforts and education to professionals. As
    a complement to our study, qualitative research is needed for a better understanding of young peoples’ choices—why, when
    and to whom they disclose or not!

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    http://www.ssd.scb.se/databaser/makro/Produkt.asp%3Fproduktid=UF0507

      Child sexual abuse is largely hidden from the adult society

      Introduction

      Method

      Participants

      Procedure

      Measures

      Ethical considerations

      Results

      Sexual abuse rates

      Disclosure rates and recipients of disclosure

      Univariate analyses

      Multivariate analyses-predictors of non-disclosure

      Discussion

      Disclosure rate

      Disclosures are hidden from adult society

      Gender differences in disclosure patterns

      The professional system

      Predictors of non-disclosure

      Mental health

      Implications for practice

      Conclusion

      References

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